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THE SINGULAR CASE OF A LADY, WHO HAD THE SMALL-POX DURING PREGNANCY; AND WHO COMMUNICATED THE SAME DISEASE TO THE FOETUS.

BY W. LYNN, SURGEON.

AS READ AT THE ROYAL SOCIETY IN FEBRUARY 1786.

LONDON: PRINTED BY C. MACRAE, ORANGE STREET.

A SINGULAR CASE.

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EVERY circumſtance which tends to elucidate any doubtful point in the animal oeconomy, as it adds to the ſtore of our knowledge, muſt of courſe contribute to ſettle the practice of phyſic and ſurgery upon more certain and rational principles.

[4]

Whether a foetus can receive the infection of the ſmall-pox, or any other contagious diſtemper, from its mother in the womb, is a queſtion which appears not to have been ſatisfactorily ſolved. Many eminent phyſiologiſts have been divided in their opinions upon this ſubject.

In the caſe publiſhed by Mr. John Hunter, in 1777, the point is far from being aſcertained, to the full conviction of that celebrated teacher's own mind; ſince, after having related the caſe, he collects the beſt authorities on both ſides of the queſtion, and leaves the deciſion to the reader's own judgment.

[5]

It is to ſettle this matter beyond the poſſibility of future controverſy, that the following facts are, with all reſpect and deference, ſubmitted to the conſideration of this learned Society.

In November, 1785, the wife of Mr. Eve, a coachmaker in Oxford-ſtreet, being then in the eighth month of her pregnancy, was ſeized with rigors, pain in the back, and other febrile ſymptoms. In two days time, the diſeaſe ſhewed itſelf to be the ſmall-pox; and though the puſtules were of the diſtinct ſort, yet they were uncommonly numerous. [6]On the eleventh day they began to turn; and on the twenty-ſecond day her labour took place, which, according to her reckoning, was a fortnight before the regular period; that is, when ſhe was advanced in her pregnancy eight months and two weeks.

The child, at the time of its birth, was covered with diſtinct puſtules all over its body: they did not appear to be full of matter till three days after; at which time I took ſome of the pus upon a lancet, from one of the puſtules on the face. With this lancet I afterwards inoculated, [7]on the 2d of December, 1785, a child of Mr. Chaters, in Church-ſtreet, Soho, in both arms. On the 7th the inflammation began to appear in each arm, and continued daily increaſing till the 11th of December, when the child ſickened, and was affected with all the ſymptoms which uſually precede the eruption. On the 12th the ſickneſs and fever abated, the puſtules of the diſtinct ſort of ſmall-pox made their appearance, and the child having regularly gone through the ſeveral ſtages of the diſtemper, was perfectly well in three weeks.

[8]

It may be proper to obſerve, that Mr. Findlay, ſurgeon, in Sackville Street, and Mr. Holladay, late ſurgeon to Sir Edward Hughes, in the Eaſt-Indies, were preſent, both at the taking of the matter, and at the ſubſequent inoculation of the child.

As no circumſtance can prove the identity of the ſmall-pox more indiſputably, than its being communicated, with the uſual ſymptoms and progreſſion of the diſeaſe, from one ſubject to another; ſo it appears to be aſcertained from the above facts, that a child can receive the variolous infection from its mother, in utero.

REMARKS.

[9]

ALTHO' the fact of the poſſibility of the ſmall-pox being communicated from the mother to the foetus, in utero, be clearly proved in this caſe, yet there may ſtill remain ſome doubt with reſpect to the mode of communication.

It may be urged, that if we ſuppoſe the communication of the diſeaſe [10]from the mother to the child to be effected by means of the circulating fluids, then the child would never eſcape the infection, when the mother had the diſeaſe; whereas the contrary appears in the inſtance adduced by Mr. John Hunter from Boerhave, of a lady who having gone through the confluent ſmall-pox in the ſixth month of her pregnancy, brought forth afterwards, at the regular period, a child, whoſe body did not ſhew the leaſt veſtige of the diſeaſe.

To this it may be anſwered: It is by no means neceſſary, ſuppoſing [11]the contagion to be conveyed by the circulating fluids, that there ſhould be no poſſibility of the child's eſcaping the diſeaſe, becauſe this aſſertion proves too much. For it appears, that there muſt always be a certain aptitude or fitneſs in a body to receive any infection offered to it; and that unleſs this fitneſs or aptitude prevails, the infection will not take place. What this fitneſs or aptitude is, we cannot tell; but that it really doth exiſt, is evident from daily and palpable experience; otherwiſe, every perſon expoſed to any contagious diſeaſe would never eſcape. How many are there reſpecting [12]the diſeaſe in queſtion, who never having had it themſelves, are caſually or purpoſely expoſed to infection, and eſcape it ſeveral times, while they ſhall catch it upon another occaſion, when perhaps they leaſt expected it? Nor is there any reaſon which can induce us to ſuppoſe, that this aptitude or fitneſs for receiving infection is not as neceſſary to produce the diſeaſe, when the virus is immediately conveyed by the circulating fluids, as when it is previouſly to be abſorbed: For in the inſtances alledged, although the virus had not acted upon the conſtitution [13]ſo as to produce the diſeaſe, yet we cannot ſuppoſe the whole abſorbent ſyſtem to be entirely inactive, ſo as that no particle of matter, capable of infecting, ſhall be taken up by the body, repeatedly expoſed to it. The action and power of the abſorbent ſyſtem muſt go on; and therefore, when a contagious diſtemper is not produced in any body expoſed to it, this can only be accounted for, from the inaptitude or unfitneſs of the conſtitution to produce it at the time, however myſterious that inaptitude or unfitneſs may be.

[14]

In the caſe mentioned by Boerhave, if the foregoing reaſoning has been well founded, we might ſuppoſe that there was a want of aptitude in the foetus to receive the infection, although it was circulating in the fluids of the mother; or there is another way of conſidering it, which is, that the child had really gone through the ſmall-pox in utero, but had been born without any marks. How many are there who go through the diſeaſe, and never bear the leaſt veſtige of it afterwards?

In this caſe, there was full time enough for the child to catch the [15]infection, go through the ſeveral ſtages of it, and come into the world without a ſpot; for the lady having had the diſeaſe in the ſixth month, implies, that ſhe had gone through it before the ſix months were completed; conſequently there were full three months remaining before the child came into the world.

Suppoſing, therefore, the child to have gone through the diſeaſe before the ſeventh month was accompliſhed, it had ſtill upwards of two months to get rid of any marks remaining from any previous puſtules it might have had; and is it not [16]extremely probable, that the circumſtance of the child's being entirely ſecluded from the external air, at that period, may have contributed much to aboliſh or ſhorten the duration of theſe marks? Again; every one knows from daily experience, that becauſe the mother had a confluent ſmall-pox, there was no neceſſity that the child ſhould have one of the ſame kind.

If it be poſſible, then, that the child ſhould have had a mild ſmall-pox, it is on the other hand impoſſible to aſcertain the number of puſtules it might have had. One or two [17]are ſufficient to characteriſe the diſtemper, and many perſons go through it, both in the natural way and by inoculation, with no other external mark. Some eminent phyſicians indeed, among whom is Boerhave, have been of opinion, that the eruption is not abſolutely neceſſary to conſtitute the diſeaſe; and that a perſon may go through the variolous fever without any apparent eruption, and be as free from future infection as if the eruption had appeared.

There is nothing, therefore, which militates againſt the ſuppoſition of the contagion being conveyed [18]from the mother to the foetus in utero, by means of the circulating fluids; even in thoſe inſtances adduced of the child having caught the diſtemper in the womb of its mother, who had previouſly experienced it, and therefore was not herſelf ſuſceptible of it. Can we ſuppoſe the diſeaſe to be conveyed to the child any way, then, through the mother? A ſubject may abſorb, and convey an infection to another, of which it is not itſelf ſuſceptible; and in this caſe, the mother becomes the vehicle of a poiſon, which cannot poſſibly have any effect upon herſelf.

[19]

But, if the ſmall-pox was conveyed to the child in this caſe, thro' the medium of the circulating fluids, which indeed appears to be the only way by which it could be conveyed, it follows, that other contagious diſeaſes may be communicated from the mother to the foetus in utero, through the ſame channel; and therefore, the poſſibility of the like event extends to the Venereal Diſeaſe.

FINIS.
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Citation Suggestion for this Object
TextGrid Repository (2020). TEI. 5644 The singular case of a lady who had the small pox during pregnancy and who communicated the same disease to the foetus By W Lynn Surgeon As read at the Royal Society in February 1786. University of Oxford Text Archive. . https://hdl.handle.net/21.T11991/0000-001A-5B52-2